Review Reports - Heatwaves and Public Health: A Bibliometric Exploration of Climate Change Impacts and Adaptation Strategies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This research tries to identify the research trends at the intersection of extreme heat and human health. To achieve this the authors reviewed the literature and used bibliographic analysis to assess research developments. But this paper would benefit from greater depth in several areas -

One of the goals of this research paper is to evaluate the effectiveness of adaptive strategies in reducing health vulnerabilities to heat events. There is no attempt to achieve this.
Key statistics for review papers in this realm are the most cited author, total and average citation per year, Most cited articles, and thematic evolutions. The research is limited in its geographical representation, as it only features two authors from Australia, but no data is presented from the other continents/countries. Expand the analysis/results to include authors and citations across other countries.
You mention that in this study, you used IPCC, Copernicus, and NOAA datasets for cross-validation. However, I could not find any cross-validation in the results section of your paper!
4. The figures in this paper do not match the academic publication standards, especially figures 4 and 5.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Abstract

Line 20-33

Show the numbers right away in the abstract so that the readers can quantitatively understand the gist of your research.

Bibliographic analysis should be included in the keywords.

Section 1 Introduction

Line 42-43

How can you say that direct and indirect consequences remain critically understudied?

In line [237], you said “increasing heatwaves have heightened scientific and public health interest” and also provided citations for it. And after that, you discuss the direct and indirect consequences!

In your literature review, you provide numerous citations in section 3.4 related to the impact of heat on human health. Line [251-275]

Line 78-83

Could you expand on how this study utilizes the framework of these theories?

Line 84

You’ve already established in Line 61 that this study uses bibliometric analysis. Do not repeat.

Section 2 Methods

Section 2.1

The text and Figure 1 are not consistent with each other. The text reads 292 research articles meet the threshold, but in the figure, it says 312 studies are included in the review. Also, the figure shows there are 312 records excluded.

This figure looks exactly like Figure 1 in this paper. Consider changing it. Also, cite and read the research for its presentation strategies, search methods, and inclusion criteria.

Gkouliaveras, V., Kalogiannidis, S., Kalfas, D., & Kontsas, S. (2025). Effects of Climate Change on Health and Health Systems: A Systematic Review of Preparedness, Resilience, and Challenges. International journal of environmental research and public health, 22(2), 232. https://doi.org/10.3390/ijerph22020232

Line 137

This statement can be improved for clarity.

Line 140-141

Improve the sentence.

Line 140-141

Which studies are most cited in heatwave research, and for which specific aspects are they cited? Are those citations relevant of this review?

I believe this is where you could you the statistics that I mentioned earlier.

Section 3 Results

Section 3.1

In the introduction section, you stated that Bibliometric analysis is a “quantitative” method for conducting this research. Therefore, you should demonstrate that by showing numbers, percentages, or descriptive statistics.

Line 134-136

Figure 2 needs to be improved. Do not just show the screenshot.

Line 152-155

Show the numbers - How many/What % from each of those Journals.

Line 158

How do we know that these are the research focus areas without any numbers to back up your claim? Are the readers supposed to believe you just because you wrote it?

Line 163-166

Again, there are no numbers to back up this statement.

In my view, revise the whole paragraph because it is unclear what the author wants to convey.

Section 3.2

Figure 3 does not illustrate the geographic distribution of Heatwave and Health research! It merely displays the number of publications in the Journals.

Line 174-177

This is a recommendation. Could be moved to the conclusion.

Line 203-206

It is unclear what the authors want to state!

Recreate Figure 6 - Black background is looking utterly poor and is far from publication standards.

Line 203-204

How do you classify the East and the West?

Line 231

What other challenges?

Line 231-234

The sentence can be improved.

So, what are the key themes that are evolving? Looking at the figure and reading through the paragraphs, it is unclear what the key themes are and how you came up with, for example, climate change and health as one of the key themes. It appears that you searched for the words that were most frequently repeated in the literature in your database.

Either change the figure or insert a table showing the trends across these themes.

Line 242-243

Do local climate conditions alone influence population adaptation?

Section 3.5

Line 285

The population from rural areas does relocate to urban cities due to economic pressures, but these are driven by many other factors, such as xxxx, not just climate change.

Line 291-293

Could you change the word exacerbate, it's repeated twice in this paragraph.

Outdoor laborers are also present in cities, not just in rural areas. They are also vulnerable to extreme heat.

line 299-300

Elaborate on how these interventions can help to protect at-risk populations.

Section 3.6

Line 305-308

What % of research from your database belongs to each of these cities?

Consider including a figure to show the top regions and their respective share of the research articles.

Line 313-314, 328-330

Explain how the use of heat stress indices supports the vulnerable from exposure to heatwaves?

Section 3.7

How can you say there is limited research on the ability of healthcare infrastructure to cope with the rising emergency hospitalizations and long-term medical consequences? I mean, you only searched for the words' heat stress' and 'public health' in the Web of Science database, so it is possible that you may not have come across such research. And if you really want to make this claim, then back it up with the numbers.

Excessive use of the word 'exacerbated'. Consider revising your writing.

Section 4 Conclusions

Rewrite after improving the manuscript.

Author Response

Dear Reviewer

Thank you for taking the time to provide a comprehensive review of our submission. We found the reviews quite engaging, and we tried to address the concerns. We believe the manuscript has been significantly improved, thanks to your invaluable insights.

Kind Regards

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a well written and well structured analysis of the current heatwave literature.

I have no specific comments for improvement and congratulate the authors on such a robust piece of work.

Comments for author File: Comments.pdf

Author Response

Comment 1: This is a well written and well structured analysis of the current heatwave literature.
I have no specific comments for improvement and congratulate the authors on such a robust piece of
work.

Response 1: We sincerely thank the Reviewer for taking the time to review our manuscript. We are truly grateful for the positive and encouraging comments on our research work.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript conducts a bibliometric analysis of ~900 Web of Science articles (2004–2024) on heatwaves and public health, mapping publication growth, leading countries/institutions, and thematic clusters spanning mortality/morbidity, urban heat, vulnerable populations, and adaptation strategies (e.g., heat-health warning systems, greening). It finds rapid post-2016 expansion concentrated in high-income countries with notable gaps in Africa and South America, and concludes that heterogeneous heatwave definitions and limited evaluative evidence hinder comparability—prompting calls for standardized metrics, data sharing, and stronger links between early warning systems and health services. However, before considering for publication, several points should be addressed.

Specific comment, section by section:

Introduction

You motivate the topic well but conflate “record warmest year” statements with formal detection/attribution of heatwaves; cite attribution literature or narrow the claim. Also avoid repeating general climate impacts unless directly linked to the bibliometric rationale.
The claim to “cross-validate” bibliometrics with IPCC/Copernicus/NOAA data is compelling but currently unsupported. Either remove or move the promise into Methods with a clear protocol and output (e.g., correlation between annual publication counts and global temperature anomalies).

Methods

Provide the exact Boolean query string in full, including parentheses and field tags (e.g., TS=(...)), as executed in WoS, plus the search date and WoS indexes (SCI-EXPANDED/SSCI/ESCI, etc.). The current text is ambiguous and split across lines; parentheses and operators (“OR/AND”) are unclear. Include it in a reproducible appendix.
Report document types retained (you state journal articles only) and show a PRISMA-style flow with numeric reasons for exclusion (language, document type, duplicates). Figure 1 is mentioned but not described in enough detail for replication.
Limiting to WoS only introduces selection bias for Global South outputs and public-health outlets indexed more comprehensively in Scopus. Either (i) justify WoS-only with sensitivity analysis, or (ii) merge WoS + Scopus with a deduplication protocol (DOI/Title match), as you note as common practice in the literature.
You state initial retrieval = 1,213 → 1,125 (time filter) → 1,101 (English) → 901 (articles). Provide exact inclusion/exclusion criteria and date ranges applied by WoS filters; show them inside the PRISMA figure and in text.
You state, “Fractional counting offers numerous advantages, such as.” The sentence is incomplete and needs the actual rationale (mitigates bias from multi-authored records, fair credit distribution, etc.).
Justify the keyword threshold = 5 (292/3574 kept). Provide a sensitivity analysis (e.g., thresholds 3/7/10) to show cluster robustness and whether major themes persist.
Specify sources (IPCC which report/figure; Copernicus which product; NOAA which index), variables (e.g., global mean surface temperature anomaly), temporal aggregation, and statistical approach (e.g., Spearman correlation between annual publication counts and GMST; change-point analysis; Granger causality not appropriate here but trend co-evolution is). Without this, the interdisciplinary claim is not verifiable.
Add an explicit methodological limitations paragraph: English-only, WoS-only, keyword-based retrieval (risk of missed synonyms like “thermal stress,” “heat-related illness”), and definition heterogeneity for “heatwave”. This will contextualize Results.

Results

Quantification & diagnostics. Provide the exact annual counts and fit a trend model (e.g., piecewise linear with 2016/2020 breakpoints) rather than narrative descriptors. The text mentions “single publication in 2005” and “>200 in 2024”; include the full series in a table/figure caption with source note (WoS Analysis export).
Citations. You report 37,659 citations for 901 articles (mean 41.8). Show median and IQR to reduce skew from highly cited outliers, and state the citation window as of the search date.

Per-capita/normalization. Country tallies should be normalized by population, GDP, and R&D expenditure to avoid over-interpreting raw counts (e.g., Australia “top” output). Consider international collaboration networks and fractional vs full counting at the country level.
Regional gap framing. Good identification of Africa/South America gaps; add map figure caption that states counting method and projection of affiliations (first author vs all authors).

Bibliometric vs narrative mixing. Sections summarize health literature well but drift into a traditional narrative review without bibliometric backing (e.g., cluster labels, top keywords per cluster, evolution overlay). Tie each claim to bibliometric outputs: cluster color, top terms, representative references by co-citation bursts.
Age-group effects & mental health. Solid points; consider a facet analysis (keyword co-occurrence filtered by “mental health,” “occupational”) to quantify the share of corpus devoted to these topics over time.

Evidence of effectiveness. Many adaptations (HVIs, HHAPs, green/white roofs) are listed; add bibliometric evidence (e.g., co-citation clusters linking adaptation with health outcomes) or a targeted sub-analysis of intervention studies.

Early warning & dashboards. When recommending national dashboards, specify minimum data elements (WBGT, UTCI, EHF, hospital admissions, EMS calls) to increase actionability.

Discussion

From patterns to explanations. Move beyond counts to explain drivers of research growth (e.g., post-2016 Paris momentum; 2018/2019 European heatwaves; funding cycles). Tie to the (now-formalized) climate-data overlay analysis if retained.
Equity lens. Deepen analysis of knowledge inequities: funding, indexing bias, APCs, and language bias. Offer concrete capacity-building levers (regional repositories, multilingual abstracts) rather than only documenting gaps.
Causality caution. Avoid implying causal links between publication trends and specific heat events without formal analysis; present as co-evolution and, if possible, show correlation with lag.

Conclusions

Sharpen and de-duplicate. The conclusions restate much of the Results. Tighten to 3–4 takeaways: (i) growth and thematic foci; (ii) geography/inequity; (iii) definition/standardization gap; (iv) priority policy levers with evidence strength (strong/moderate/limited).

General comment:

Figure 1 (PRISMA). Ensure numbers match text; include all exclusion reasons with counts. Currently under-specified.
Figure 2 (trends). Add axis labels, units, citation window, and note on database export date; include separate panels for publications vs citations to avoid dual-axis ambiguity.
Figure 3 naming conflict. “Figure 3” appears to denote both “Major focus fields” and a geographic map in the prose; ensure consistent numbering and cross-refs.
Provide a table of top journals, countries, institutions, authors (with fractional counts, total link strength). This will make statements about leaders auditable.

Coverage & consistency. References mix journal styles and include some items that look like placeholders or lack page ranges; ensure uniform formatting (journal names, volume/issue/pages/DOIs). Also verify that works asserted as “pioneering” are indeed represented and that each in-text bracketed range maps to listed references.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer

Kind Regards

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

This research needs major improvements in providing quantitative data to support its claims. It still lacks robust statistics to support the authors' statements. It seems the authors have not analyzed the data sufficiently to conduct a comprehensive review. I would suggest that authors read and understand these two articles for their presentation of results, which effectively utilize numbers and percentages. They have also displayed the data in the figures.

Marx, W., Haunschild, R., & Bornmann, L. (2021). Heat waves: a hot topic in climate change research. Theoretical and applied climatology, 146(1), 781-800.

Sweileh, W. M. (2020). Bibliometric analysis of peer-reviewed literature on climate change and human health with an emphasis on infectious diseases. Globalization and health, 16(1), 44.

In this second paper, think about how they have presented their research results. They have backed their claims by incorporating numbers in their sentences.

The section on research themes is divided among the clusters, where each statement includes the number of occurrences of the items and terms. The geographic distribution section presents the number and percentage of research articles by region/country before moving on to the link strength.

They also have a section on citation analysis that provides quantifiable information on the most cited articles.

Abstract

Line 20-33

Show the numbers right away in the abstract so that the readers can quickly and quantitatively understand what you found through this research.

Section 1 Introduction

Line 42-43

How can you say that direct and indirect consequences remain critically understudied?

Line 78-79

Remove the word some of - Instead, you could say “To identify the adaptive strategies to reduce health vulnerabilities to heat events”

Section 3 Results

Section 3.1

Figure 4 & Figure 5 - Capitalize the first letter in the names of the Authors and Countries.

Line 317

“heat” stress is repeated twice. Add “cardiovascular issues”

Section 3.6

Line 305-308

You have the data - find out how many

What % of research from your database belongs to each of these cities?

Section 4 Conclusions

Rewrite after improving the manuscript.

Comments for author File: Comments.pdf

Author Response

Dear Sir/Madam

Thank you for the feedback. We have made an effort to address issues raised as we understand them from a scientific perspective. We hope you will find the revised submission much improved as per your request.

Kind Regards

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I have accepted a manuscript in the current format.

Comments for author File: Comments.pdf

Author Response

Dear Sir/Madam

Thank you for the positive feedback.

Kind Regards